Volume 1,
Issue 2,
2009

The official policy of this journal states that it is a regional journal for southern Africa and the African continent and that it specifically seeks to act as a forum for the discussion of issues of local importance and of specific importance to the developing world. When considering important malignancies in women of Africa and southern Africa, breast cancer and cervical cancer rank by far the highest. This second edition of the SAJGO focuses strongly on these two malignancies.

Women treated with trastuzumab have an increased risk for developing cardiac problems, particularly if they receive prior or concurrent anthracyclines. Left ventricular dysfunction associated with trastuzumab treatment may progress to severe New York Heart Association (NYHA) class III/IV heart failure which carries its own chronic disability and mortality. Whilst it would appear that the cardiac dysfunction is partially reversible and responds to standard medication, its natural course is currently unknown and longer term data are required. Preclinical studies have attempted to elucidate trastuzumab's mechanism of cardiotoxity and this is an area of innovative research. Myocardial HER-2 receptors are crucial for embryonic cardiac development and for maintaining adult ventricular structure and function. It is thought that sequential stress mechanisms may contribute to the pathogenesis of cardiac dysfunction. The challenge remains to identify the risks and to tailor trastuzumab treatment for each patient, to conscientiously monitor cardiac function and to institute appropriate measures if necessary, in order to ensure that HER-2 positive breast cancer patients receive the best possible care.

Breast carcinoma is common in women and forms an integral part of the BRCA familial cancer syndromes. As breast cancer is considered a heterogeneous disease, clinicians have traditionally relied on clinical and morphologic findings, as well as hormone receptor / HER-2 status for prognostic and predictive categorisation of tumours. Recently, breast cancer subclassification has been aided by the discovery of various gene expression profiles, compiled after simultaneous examination of multiple tumour biomarker genes. Basal-like breast cancer was delineated using this methodology and demonstrates significant overlap with so-called triple negative and BRCA1-associated breast carcinomas. This article describes the pathology and biology of these three groups of tumours and examines the relationship between them. Therapeutic implications are also briefly discussed.

It is accepted that high risk human papilloma virus (HPV) types are the carcinogens for cancer of the cervix. Cervical carcinogenesis is a slow process where cellular changes occur after integration of HPV DNA into the host genome. This dysplasia may revert to normal or may increase in severity over time and in a minority of patients may ultimately progress to invasive cervical carcinoma. For most patients caught in the process of cervical carcinogenesis the status will be that of noninvasive cancer and the diagnosis will be Cervical Intra-epithelial Neoplasia (CIN). This diagnosis creates a window of opportunity to manage the premalignant lesion and thus prevent further malignant progression.

Cervix carcinoma is one of the most prevalent cancers in women in Africa. Primary and secondary prevention measures in place are currently not sufficient to prevent further cases. Radiotherapy is the main therapeutic option as most cases present at a locally advanced stage. Unfortunately radiotherapy resources are scarce and literature considering outcomes for radiation treatment in Africa is limited. This review will highlight the difficulties in access to treatment, examine international meta-analyses and African literature related to radiation treatment, and discusses the special considerations needed when adapting international treatment standards to the developing world.

We report on a rare case of a woman presenting with an early intra-uterine pregnancy, lower abdominal pain and a right-sided pelvic mass. She developed an acute abdomen and an emergency laparotomy was performed. Histology revealed an ectopic invasive molar pregnancy. To our knowledge, this is the first reported case of a normal intra-uterine pregnancy with an ectopic invasive molar pregnancy.

Carcinoma of the cervix is the most common cancer of women in Africa comprising 23 percent of all reported cancers in women. The incidence rate in South Africa is approximately 35/100 000 women years, one of the highest incidence rates in the world. In the last two decades, the aetiological role of the human papilloma virus (HPV) infection in the development of pre-invasive and invasive lesions of the cervix, vagina and the ano-genital region has been conclusively established. The understanding of the oncogenesis of cervical cancer has improved to such an extent that new technologies to detect persistent HPV infection are available and are becoming part of clinical practice. HPV16 is associated with more than 50% of all invasive cervical carcinomas, HPV18 with 16% and HPV31 with 8%. Protection against the most potent carcinogen is a classic example of primary prevention. HPV6 and 11 cause genital warts.

Pfizer recently announced results from a randomized Phase 3 trial of Sutent (sunitinib malate) in patients with advanced pancreatic islet cell tumors, also known as pancreatic neuroendocrine tumors, which is a different type of cancer than the more common pancreatic adenocarcinoma. Study findings demonstrated that median progression-free survival (PFS) was 11.1 months in patients treated with Sutent compared to 5.5 months in patients treated with placebo. Researchers today presented these data at the 11th World Congress on Gastrointestinal Cancer in Barcelona, Spain. The independent Data Monitoring Committee (DMC) recommended halting the trial earlier this year because Sutent showed significant benefit and the study had met its primary endpoint. Full analysis of the data is ongoing.

Lilly today announced that their pemetrexed for injection has been approved for a histologically-based use in the first-line treatment of advanced non-small-cell lung cancer (NSCLC), the most common form of lung cancer.

Thousands of South African lung cancer patients could now live longer and with improved quality of life if they receive Tarceva® (erlonitib), a novel alternative to traditional chemotherapy, recently approved by the Medicines Control Council (MCC).